The formal definitions for the elements in the coverage resource. Also available as an XML file.
| Coverage |
| Definition | Financial instrument by which payment information for health care |
| Control | 1..1 |
| Requirements | Health care programs and insurers are significant payors of health service costs |
| RIM Mapping | Coverage |
| Coverage.issuer |
| Definition | The program or plan underwriter or payor. |
| Control | 1..1 |
| Type | Resource(Organization) |
| Must Understand | true |
| Requirements | Need to identify the issuer to target for processing and for coordination of benefit processing. |
| Coverage.period |
| Definition | Time period during which the coverage is in force. A missing start date indicates the start date isn't known, a missing end date means the coverage is continuing to be in force. |
| Control | 0..1 |
| Type | Period |
| Must Understand | true |
| Coverage.type |
| Definition | The type of coverage: social program, medical plan, accident coverage (workers compensation, auto), group health. |
| Control | 1..1 |
| Type | Coding from ActCoverageTypeCode |
| Must Understand | true |
| Requirements | The order of application of coverages is dependent on the types of coverage. |
| Coverage.identifier |
| Definition | The main, may be the only, identifier for the coverage - often referred to as a Subscriber Id, Certificate number or Personal Health Number or Case ID. |
| Control | 1..1 |
| Type | Identifier |
| Must Understand | true |
| Requirements | This value may uniquely identify the coverage or it may be used in conjunction with the additional identifiers below. |
| Coverage.plan |
| Definition | Identifies a style or collective of coverage issues by the underwriter, for example may be used to identify a class of coverage or employer group. May also be referred to as a Policy or Group ID. |
| Control | 0..1 |
| Type | Identifier |
| Must Understand | true |
| Coverage.subplan |
| Definition | Identifies a sub-style or sub-collective of coverage issues by the underwriter, for example may be used to identify a specific employer group within a class of employers. May be referred to as a Section or Division ID. |
| Control | 0..1 |
| Type | Identifier |
| Must Understand | true |
| Coverage.dependent |
| Definition | A unique identifier for a dependent under the coverage. |
| Control | 0..1 |
| Type | integer |
| Must Understand | true |
| Requirements | For some coverage a single identifier is issued to the PolicyHolder and dependent number issues to each to each of their dependents to track and manage the plan. |
| Coverage.sequence |
| Definition | An optional counter for a particular instance of the identified coverage which increments upon each renewal. |
| Control | 0..1 |
| Type | integer |
| Must Understand | true |
| Requirements | Some coverage, for example social plans, may be offered in short time increments, for example for a week or a month at a time, so while the rest of the plan details and identifiers may remain constant over time, the instance is incremented with each renewal and provided to the covered party on their 'card'. |
| Coverage.planHolder |
| Definition | Planholder information |
| Control | 1..1 |
| Coverage.planHolder.name |
| Definition | The name of the PolicyHolder |
| Control | 1..1 |
| Type | HumanName |
| Must Understand | true |
| Requirements | Used to validate coverage |
| Coverage.planHolder.address |
| Definition | The mailing address, typically home, of the PolicyHolder |
| Control | 1..1 |
| Type | Address |
| Must Understand | true |
| Coverage.planHolder.birthdate |
| Definition | The date of birth of the PolicyHolder |
| Control | 1..1 |
| Type | date |
| Must Understand | true |
| Requirements | Used to validate coverage |
| Coverage.extension |
| Definition | See Extensions |
| Control | 0..* |
| Type | Extension |
| Coverage.text |
| Definition | Text summary of resource (for human interpretation) |
| Control | 1..1 |
| Type | Narrative |
. Page versions: R5 R4B R4 R3 R2
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